Low retention of HIV‐infected patients on antiretroviral therapy in 11 clinical centres in West Africa

Ekouévi, Didier K.; Balestre, Eric; Ba-Gomis, Franck-Olivier; Eholié, Serge; Maïga, M. Y.; Amani-Bossé, Clarisse; Minga, Albert; Messou, Eugène; Sow, Papa Salif; Lewden, Charlotte; Traore, H; Bissagnené, E.; Dabis, François

doi:10.1111/j.1365-3156.2010.02505.x

Cited by 81 publications

(70 citation statements)

References 19 publications

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“…However we must note that more females than males were lost to follow up in this study. This differs from other studies in a number of settings that find male sex a predictor of poor retention [34] (Geng retention) including in a multisite study from West Africa [35], South Africa [36], Western Kenya [37] and Malawi [38].…”

Section: Discussioncontrasting

confidence: 84%

A Participatory Approach to Improving Retention in HIV Treatment and Care for Newly Diagnosed Patients in a Secondary Health Facility in Sierra Leone

Ameyan¹,

Kamara²,

Sesay³

et al. 2017

J AIDS Clin Res

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The bottom line for any successful HIV program is adherence to therapy and retention in care with the subsequent benefit of achieving undetectable viral levels. Research has shown that poor retention in care for HIV infection has a negative impact on survival and health outcomes. This study aimed to improve retention in care at a secondary health in Freetown, Sierra Leone through a participatory approach that involved health workers and support groups. Our interventions included implementing a participatory needs assessment, reorganising the patient flow, improving communication between health workers and people living with HIV/AIDS (PLHIV), trainings and capacity building and improving the content of support group meetings. The baseline period was from June 2012 to June 2013 while the post intervention period was from June 2013 to June 2014. At baseline, a total of 47 patients were newly diagnosed out of which 19 were male and 28 were female. The median age was 32. Twenty were single, 18 married, 7 widowed and one divorced with one confirmed dead. In all, 15 were retained in care while 31 were lost to follow up. Our baseline retention was therefore 33%. Post intervention, a total of 54 patients was newly diagnosed out of which 48 were female and six were male. The median age was 29. Twenty were single, 27 married and 7 widowed. Eleven were confirmed dead and 1 asked to be transferred to a nearby facility due to reasons of distance. Thirty nine were retained in care while three were lost to follow up. Our baseline retention was therefore 93%. The results therefore showed that retention in care improved from 33% to 93% over a 6 month period. We conclude that while there are generic interventions that could be applied at program level to improve retention in care, interventions need to be context specific and fully participatory to cater to the multi-pronged yet unique peculiarities of every setting.

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Section: Discussioncontrasting

confidence: 84%

A Participatory Approach to Improving Retention in HIV Treatment and Care for Newly Diagnosed Patients in a Secondary Health Facility in Sierra Leone

Ameyan¹,

Kamara²,

Sesay³

et al. 2017

J AIDS Clin Res

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“…These include syntheses of reasons for stopping treatment 10,11 and pooled analyses of data from multiple cohorts in a region 12 . Quantitative results have generally been similar to ours, though several authors have noted that the definition of loss can influence estimated rates 13,14 .…”

Section: Discussionmentioning

confidence: 99%

Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries

Fox

Rosen

2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

281

247

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Background We previously published systematic reviews of retention in care after antiretroviral therapy initiation among general adult populations in sub-Saharan Africa. We estimated 36-month retention at 73% for publications from 2007–2010. This report extends the review to cover 2008–2013 and expands it to all low- and middle-income countries. Methods We searched PubMed, Embase, Cochrane Register, and ISI Web of Science from January 1, 2008 to December 31, 2013 and abstracts from AIDS and IAS from 2008–2013. We estimated retention across cohorts using simple averages and interpolated missing times through the last time reported. We estimated all-cause attrition (death, loss to follow-up) for patients receiving first-line ART in routine settings in low- and middle-income countries. Results We found 123 papers and abstracts reporting retention for 154 patient cohorts and 1,554,773 patients in 42 countries. Overall, 43% of all patients not retained were known to have died. Unweighted averages of reported retention was 78%, 71% and 69% at 12, 24, and 36 months after treatment initiation, respectively. We estimated 36-month retention at 65% in Africa, 80% in Asia, and 64% in Latin America and the Caribbean. From lifetable analysis, we estimated retention at 12, 24, 36, 48 and 60 months at 83%, 74%, 68%, 64% and 60%, respectively. Conclusions Retention at 36 months on treatment averages 65–70%. There are several important gaps in the evidence-base, which could be filled by further research, especially in terms of geographic coverage and duration of follow-up.

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“…A recent analysis on South African cohorts suggested that although trends in early (at 12 months) mortality have declined over time from 2002-2007, the rate of loss to follow-up has increased [59,69]. Loss to follow-up at 6-12 months is around 25% in several African cohorts [70][71][72][73][74]. Further, the loss to follow-up is highest in those with lower baseline CD4 þ cell counts who are at greater risk of death [53 ,64,75-77].…”

Section: Cd4r Counts At Combination Antiretroviral Therapy Initiationmentioning

confidence: 99%

Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries

Achhra¹,

Phanuphak

Amin³

2011

Current Opinion in HIV and AIDS

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LMICs cohorts report similar immunological responses to cART as high-income countries in first 4-5 years of follow-up. Sustaining success in these settings is dependent on timely access to first-line and future cART options, efforts to reduce loss to follow-up, and implementation of treatment guidelines. Cohorts from LMICs are encouraged to continue improving treatment programs and to continue reporting outcomes over the next decade, as surveillance for potential future blunting in responses.

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Low retention of HIV‐infected patients on antiretroviral therapy in 11 clinical centres in West Africa

Cited by 81 publications

References 19 publications

A Participatory Approach to Improving Retention in HIV Treatment and Care for Newly Diagnosed Patients in a Secondary Health Facility in Sierra Leone

A Participatory Approach to Improving Retention in HIV Treatment and Care for Newly Diagnosed Patients in a Secondary Health Facility in Sierra Leone

Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries

Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries

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